The Edwin Smith Surgical PapyrusThe
first use of "neuro" words in recorded
history

I'm thinking of a word...
A simple word...
An important word...
A word for the most important organ in the body...

The word I am thinking of is...

Move mouse over this hieroglyphic

The brain was not always held in high regard.
The Greek philosopher, Aristotle, thought the heart, not the brain,
was the location of intelligence and thought. The ancient Egyptians also
did not think much of the brain. In fact, when creating
a mummy, the Egyptians scooped out the brain through the nostrils and
threw it away. However, the heart and other internal organs were
removed carefully and preserved. These organs were then placed back into
the body or into jars that were set next to the body.

Nevertheless, the ancient Egyptians are responsible for the oldest written
record using the word "brain" and have provided the first written accounts
of the anatomy of the brain, the meninges
(coverings of the brain) and
cerebrospinal fluid. The word "brain" appears on an ancient paper-like
document (a "papyrus") called the Edwin Smith
Surgical Papyrus. This document was written around the
year 1700 BC, but is based on texts that go back to about 3000 BC. This
document is considered to be the first medical document in the history of
mankind. It is possible that the papyrus was written by the great
Egyptian physician named Imhotep.

Statue of Imhotep

A Papyrus

Hieroglyphic for "Brain"

The papyrus is a description of 48 cases that were written by an Egyptian
surgeon thousands of years ago. The papyrus is about 4.68 meters (15 ft.,
3.5 in.) long and 32.5 to 33 cm (13 in.) wide. Because some of the
document is missing, the original papyrus was probably at least 5 meters
long. Several cases are important to neuroscience because they discuss the
brain, meninges (coverings of the brain), spinal cord, and cerebrospinal
fluid for the first time in recorded history.

The surgical papyrus is named after Edwin Smith, an American Egyptologist
who was born in 1822 and died in 1906. On January 20, 1862 in the city of
Luxor, Smith bought the surgical papyrus from a dealer named Mustapha Aga.
After Smith died, his daughter, Leonora Smith, gave the papyrus to The New
York Historical Society. In 1920, James Henry Breasted, founder of the
Oriental Institute of Chicago, was asked to translate the papyrus.
Finally, in 1930, Dr. Breasted published the English translation for The
New York Historical Society (University of Chicago Press.) According to
Arlene Shaner, reference librarian of historical collections at The New
York Academy of Medicine, the papyrus was sent to the Brooklyn Museum in
1938. Ten years later, the Museum purchased most of the Egyptian
artifacts from the Society. At that time, however, the directors of the
Society and of the Museum decided that the papyrus really belonged at The
New York Academy of Medicine. The papyrus has been part of The New York
Academy of Medicine collections since December 2, 1948.

(Note: I found a dusty copy of the 1930 publication in a back corner of
the University of Washington Health Sciences Library.)

It is likely that the patients described in the 48 cases were injured by
falls (maybe from working on monuments or buildings) or were victims of
battle (many wounds appear to be caused by spears, clubs or daggers.)
The brain is mentioned 7 times throughout the papyrus. However, there is
no use of the word "nerve." Scholars of medical history have been
impressed with the rational, scientific approach to diagnosing and
treating the 48 patients. The methods used are based on rational
observation and practical treatment and are for the most part, free of
"magic" and superstition.

Each case is presented in a logical manner:

Title: the type of injury and its location are
described.

Examination: the case and the manner in which
the patient should be examined are described. The examination may include
sensory testing, probing of the wound and movement of the affected body
part. Some patients were examined more than once. The examination section
of the papyrus always starts as:

"If thou examinest a man having..."

Diagnosis: the doctor has three
choices and will say one of the following about the condition:

"An ailment which I will treat" - this is used for
injuries that most likely will be cured.

"An ailment with which I will contend" - this is used for difficult,
but not impossible cases. The doctor will try to treat the condition, but
the outcome is uncertain.

"An ailment not to be treated" - in these cases, the condition cannot
be treated at all because the injury is thought to be incurable.

The diagnosis section of the papyrus always starts as:

"Thou shouldst say concerning him..."

Treatment: these include bandages, plasters,
stitching, cauterization (heating of a wound), and
splints. Surgical dressings included honey, grease and lint.
The treatment section of the papyrus always starts as:

"Thou shouldst ..."

Glosses: these are short dictionaries of
terms. Not
all of the cases have a gloss.

Let's look at some of the cases that concern the nervous system.

Case 6

Case 6: A gaping wound in the head, fracture of
the skull and opening of the meninges. This case describes the:

Convolutions of the brain - the author of
the papyrus describes
these "like those corrugations which form molten copper." This most
likely refers to the wrinkled appearance of the brain created by the gyri
and sulci of the brain.

"Corrugations" of the Brain

Meninges (coverings of the brain) - described
as the membrane
enveloping the brain.

"Membrane" enveloping the Brain

Cerebrospinal fluid - described as the fluid in
the interior of the
head.

"Fluid" in the Interior of the Head

Case 6 was "An ailment not to be treated."

Case 8

Case 8: Fracture of the skull with no visible external injury. Apparently
this patient injured his head, but the skin remained somewhat undamaged.
This case is important because it describes which side of the body is
affected by a head injury. In this patient, there was abnormal eye
movement and paralysis of the arm and leg on the side of the body that was
the same as the head injury. Because the right side of the brain controls
the left side of the body and the left side of the brain controls the
right side of the body, it is thought that the damage to the brain was
caused by a contracoup injury. A contracoup occurs when
impact to one side of the head pushes the brain within the skull such
that the brain hits the opposite side of the skull. This results in
brain damage on the side opposite to the side receiving the impact. The
description of this case indicates that the Egyptian surgeon may have
known that the brain controlled movement.

Case 8 was "An ailment not to be treated."

Case 22

Case 22: Fracture of the temporal bone (of the skull). This patient
could not speak and this case is thought to be the first to document aphasia. If this is a description of aphasia, it would
pre-date the famous work on aphasia by Paul Broca (1861) by thousands
of years!

Cases 31 and 33

Cases 31 and 33 were both classified as "An ailment not to be treated."

Case 48

Case 48 is the last case and describes a sprain in the spinal vertebra.
When the patient was asked to move his legs, the surgeon noted that this
caused pain. The text of case 48 comes to an unexpected stop in the
middle of a sentence. This suggests that there may have been more cases
in the original papyrus.

Case 48 was "An ailment which I will treat."

Our
understanding of the brain has come a long way since 3000 BC. Now,
through brain imaging techniques such as positron emission tomography
(PET) and magnetic resonance imaging, scientists can
"look" at how the brain works. Neuroscientists also know what many parts
of the brain do, what brain cells look like and how drugs affect the
nervous system. However, many mysteries
of the mind still remain:

How are memories
formed and lost? What are the causes and cures for Alzheimer's
disease
and Parkinson's disease? Why do we sleep? What is consciousness?

These are just a few of the many unanswered questions, but like case 48 in
the papyrus, this page is coming to a sudden...

For more
information on the
Edwin Smith Surgical Papyrus and ancient Egyptian
medicine, see: